- Cardiac diagnostic testing
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Cardiac diagnostic testing


St Joseph’s Hospital offers the most comprehensive range of cardiac diagnostic testing available anywhere in the UK outside of London.


All of our equipment is new and of the highest calibre available. Our MRI Scanner is a Toshiba Vantage Helios 1.5T system, capable of cardiac MRI imaging to a higher standard than any other hospital in Wales and the south west of England, and our Toshiba Aquilion ONE 640 slice CT system is the world’s leading CT scanner. It is the only CT scanner in the world which can image soft plaque in heart arteries which is the primary cause of most heart attacks.


St Joseph’s Hospital has made a conscious decision to invest in state-of-the-art diagnostic equipment allowing our patients comprehensive cardiac assessment. We are the only private hospital in south Wales that can offer cardiac patients unsurpassable quality cardiac CT scanning with our 640 slice Toshiba Aquilion One. This scanner gives our patients complete diagnostic heart assessment in a single heartbeat (0.35s) for the lowest radiation dose possible. Other private institutions can only offer cardiac CT scanning across 3-4 heartbeats which can lead to blurring of images and scans that need to be stitched together (64 slice scanners are the minimum quality recommended scanners for performing cardiac CT in British Society of Cardiovascular Imaging recommendations) making scans inferior in comparison and requiring radiation doses that are up to 10 times greater than our CT system. We want to offer you the best scan possible and have not scrimped on our CT scanner technology. There is no better cardiac CT scanner than the Aquilion One and it’s the UK market leader for a reason.


We offer the following range of tests:

24 hour blood pressure recording


High blood pressure (hypertension) is one of the major causes or risk factors for of heart disease and stroke. It is normal for blood pressure readings to vary throughout the day and it is well known that some patients have very high readings when they are taken in a medical setting (white coat effect) but overall their ‘true’ blood pressure is satisfactory. If this situation is suspected we may recommend you wear a special recording device which records and stores your blood pressure throughout the day and night. The monitor takes blood pressures every 20 minutes (less frequently overnight). This gives us a feel for your true blood pressure. The test may also be used to check that satisfactory control is being achieved in patients taking tablets for high blood pressure.


24/48 hour and 7 day ECG recording ('Holter' recording)


Palpitations or awareness of the heartbeat are extremely common but usually only occur intermittently. A simple resting ECG will often not ‘catch’ the rhythm of the heart whilst the patient has symptoms. In this situation we will often suggest the fitting of a 24/48 hour ECG recorder. The small recorder (about the size of a small iPod) is called a SEER 1000 recorder and as you go about normal daily life the monitor makes a graphic record of the heart’s electrical currents and provides valuable information about the basic rhythm of the heart as well as the rhythm at the time of symptoms.

Sometimes palpitation symptoms are very elusive and may not be recorded during the 24/48 hours of recording. In this situation a longer period of recording using a small device you carry with you and activate at the time of symptoms (a 7 day event recorder) may be recommended.


Cardiomemo and event recorder


These are more sophisticated versions of the basic system. Whenever you have attack of symptoms, you can activate the device to record your heart’s rhythm.


The advantage of the cardiomemo is that it doesn’t have any leads, so you can just place it on your chest when you get symptoms, without having to put any leads in position.


Blood tests


Blood testing is an essential way of checking for disease and establishing the chances or risk of developing a heart problem in the future. We have access to the full range of blood tests including lipid bio-markers and the results will be available promptly – sometimes even on the day that they are taken.


Cardiac CT calcium score scan


This is a scan to look for calcium build up in the arteries of the heart (coronary calcification) which is a very early sign of furred and narrowed arteries. This usually occurs long before any symptoms of a heart problem develop and is therefore used as a screening test in people who may be at risk of heart disease.

This scan takes only a few minutes and does not require an injection.


CT Coronary Angiogram


The CT Coronary Angiogram (CTA) is used to determine if any of the coronary arteries supplying blood to the heart are narrowed or becoming blocked.

The CT Coronary Angiogram is recommended by the UK's National Institute for Clinical Excellence (NICE) as the first line investigation for the majority of patients with chest pain. It replaces the exercise treadmill test which NICE suggests has no role in the current evaluation of patients with chest pain. Our Aquilion One CT scanner can detect and distinguish life threatening soft plaque from calcified plaque, within the lumen (inside) of the artery.

You or your doctor may consider a CT Coronary Angiogram scan if:


  • you have symptoms such as chest pain which might suggest a narrowing of your heart arteries
  • you have had a CT scan or other tests that show significant coronary artery disease
  • you are at risk of heart disease and wish to have a definitive answer as to whether you have any ‘furring up’ of your heart arteries, including the dangerous soft cholesterol-rich plaques
  • your previous coronary artery angioplasty, stent or bypass graft needs to be checked for a blockage
  • you need, or would like, a less invasive alternative to a conventional angiogram


CT Coronary Angiogram with HeartFlow Fractional Flow Reserve (FFRCT)


It is traditional practice for a conventional Coronary Angiogram to be required if a CT Angiogram shows a blockage of the heart arteries which may require stenting or stretching with an angioplasty. The conventional angiogram can be used to measure the drop in blood pressure below the blockage and judge whether a stent is necessary. Like all interventional procedures a Coronary Angiogram carries with it a small risk of mortality because it is an invasive procedure.

HeartFlow FFRCT is a new computer based methodology which calculates the pressure drop from conventional CT Coronary Angiogram data. The software allows your consultant to determine whether the obstructions within your coronary arteries are causing a significant blockage, or whether the narrowing is less critical and does not require further intervention. The idea is that only patients who have significant actual stenosis go on to have more risky interventional cardiology procedures and embraces a modern way of thinking.

St Joseph’s is one of only two centres in the UK with access to this technology.


Click here to view Mr Thomas's case study


Coronary Angiogram (cardiac catheterisation)


A Coronary Angiogram is a special x-ray test designed to take pictures of the arteries of the heart. It is a safe test and is performed under local anesthetic. It’s performed to find out if your coronary arteries are clogged, where and by how much. An angiogram helps your cardiologist to see if you need treatment such as angioplasty, coronary artery bypass surgery or medical therapy.

Before the procedure, you may be given medicine to relax you, but you will stay awake. Within our catheterisation laboratory you will lie on a table near a camera and other equipment. Your cardiologist will numb a spot on your groin or arm and insert a thin tube (catheter) into an artery and up to the heart. Most people do not find this particularly uncomfortable. Special fluid is injected through the catheter to show up the coronary arteries on x-ray. Many x-rays are taken as the fluid goes through the artery. The test gives us a road map of the arteries and shows up any blockages or narrowings. The valves, pumping function and oxygen levels in the heart can also be assessed. If you wish, you can see the x-ray pictures on the screen during or after the test.

After the test, the catheter will be taken out. A nurse or doctor will apply direct pressure for 15 minutes or longer where the catheter was inserted to make sure there is no internal bleeding. You will be asked to lie quietly on your back for several hours. You won’t have to lie on your back if the catheterisation was performed from an artery in your arm. The patient will be brought back to their hospital room or Cardiac Care Unit (CCU). It is possible that the patient may feel sore where the catheter was inserted or from lying on your back. Generally we recommend that you take a few days off work after the procedure and do not drive for a couple of days.


Echocardiogram ('echo' or ultrasound)

An echocardiogram is a test that uses high-frequency sound waves (ultrasound) to create an image of the heart. The test uses sound waves to measure the speed and direction of blood flow. By combining these tests, a cardiologist receives useful information about the heart’s anatomy and function. It allows us to assess all aspects of heart function including size and thickness of the walls and chambers of the heart, the heart’s pumping function and the function of the heart valves. Echocardiography is the most common test used to diagnose or rule out heart disease and also to follow-up on patients who have already been diagnosed with a heart problem.


Echo is a completely safe and painless test and takes up to 30 minutes to perform and revolutionised the assessment of cardiac disease when it was developed in the 1970s.


Electrocardiogram (ECG)


This simple, painless test takes a few minutes to perform. It records the normal electrical activity of the heart into a tracing and this can reveal a number of different cardiac conditions. An ECG gives two major kinds of information. Firstly, it can demonstrate abnormalities of the cardiac rhythm. Secondly it can show possible abnormalities of the heart structure. As it is only a single brief snapshot of the heartbeat at rest a normal ECG does not necessarily exclude important disease of the heart. There’s no pain or risk associated with having an ECG.


Exercise tolerance test (ETT)


An exercise tolerance test is sometimes called an exercise test, stress test or a treadmill test, exercise test or stress ECG. It helps a doctor find out how well your heart handles work. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps doctors know the kind and level of exercise appropriate for a patient.

A continuous ECG is taken whilst you undergo graded standardised exercise on a treadmill. The test starts at a leisurely pace and gradually the speed and gradient increase every three minutes. The technician can stop the test at any time if needed. Blood pressure is also checked every three minutes. Afterwards the patient will sit or lie down to have their heart and blood pressure checked during recovery.

Heart rate, breathing, blood pressure, electrocardiogram and your symptoms are monitored during the test. Healthy people who take the test are at very little risk. It’s about the same as if they walk fast or jog up a big hill. Medical professionals will be on standby in case something unusual happens during the test.

Patients with coronary disease may experience symptoms and this is often associated with characteristic changes to the shape of the ECG.

Depending on the results of the exercise stress test, the doctor may recommend more tests such as a stress echo, thallium scan or cardiac catheterisation (coronary angiogram).


Specialised echo


Echocardiogram and ultrasound technology has developed very rapidly and in certain situations even more specialist forms of echo scanning of the heart is required. In certain situations our cardiologist or cardiac sonographer will give you an injection of ultrasound contrast via a cannula in your arm vein. The contrast agent can help identify abnormalities that are potential visible on the normal echo scan and the modern contrast agents are extremely safe.


Stress echo


Even in patients with severe narrowing of the hearts arteries (coronary artery disease) the echocardiogram at rest may be completely normal. In this situation however under the stress of exercise the function of the heart can become abnormal in areas of the heart where there is a problem with blood flow. Stress echo uses this fact to help us diagnose coronary artery disease and may be used as an alternative to an exercise test or perfusion (MIBI/thallium) scans. Following a detailed resting echocardiogram the heart is ‘stressed’ either by exercising you or with a special medicine injected into a small vein. The echocardiogram is then repeated and the images compared.


Stress echos are often performed on patients who are not physically fit enough to have an exercise tolerance test on a treadmill.

This test is extremely safe and you will usually only need to spend an hour or two in the hospital and go home on the same day.


Cardiac MRI perfusion

Conventionally, patients who have had CAD diagnosed by angiography need to undergo additional functional examinations such as nuclear stress imaging or cardiac MR to demonstrate that a narrowing is hemodynamically important. At St Joseph’s we can offer an alternative as part of their CT Angiogram appointment. MRI cardiac perfusion, which when combined with CTCA allows the complete assessment of a patient’s CAD in a single sitting, with a high level of accuracy but low radiation dose.

After an injection of a special drug to dilate blood vessels in the heart a further MRI scan can be performed. Diseased coronary arteries will not dilate hence causing a ‘perfusion defect’ on the scan.

Several studies have shown that MRI cardiac perfusion can be performed with good, if not better agreement than other conventional, non-invasive imaging modalities and with several advantages. The radiation dose from perfusion MRI is significantly less than nuclear perfusion imaging and in combination with CT angiography data allows patients with significant CAD and no flow limiting narrowings (the artery is narrow but the blood flow is acceptable) to be identified.


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